|
1
|
Kontakis MG, Tsagkozis P. Can Survival Scoring Systems for Spinal Metastases be Used to Predict Postoperative Neurologic Recovery? A Retrospective Study on 204 Patients With Thoracolumbar Metastases Treated at a Tertiary Center. Global Spine J 2025; 15:136-142. [PMID: 38871353 PMCID: PMC11571499 DOI: 10.1177/21925682241262691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Scoring systems for metastatic disease of the spine are used to select patients for surgical treatment based on survival estimation, but it is unknown whether they can be used to predict the outcome of surgery. This study aims to investigate the association between two widely used prognostic scores and the neurologic function after surgery. METHODS Retrospective analysis of 204 patients with thoracolumbar metastases treated with decompressive surgery at Karolinska University Hospital (2001-2020). Modified Bauer and Tokuhashi scores were categorized based on surgical indication, and post-operative neurological function was assessed using the Frankel scale at two different post-surgery intervals. RESULTS Modified Bauer scores ≥2 yielded higher late follow-up Frankel scores (3.9 ± 1.1) than scores <2 (3.5 ± 1.1), P = .03. Modified Tokuhashi scores ≥9 correlated with higher Frankel scores (4.5 ± .9) than scores <9 (3.5 ± 1.1), P < .0001. Both scoring systems positively predicted neurological outcomes at late follow-up, with odds ratios of 1.6 (P = .03) for Bauer and 9.2 (P < .0001) for Tokuhashi. However, only Tokuhashi predicted ambulatory function at late follow-up (P < .0001), demonstrating its utility in prognosticating post-surgical mobility. CONCLUSION Higher modified Bauer and Tokuhashi scores were associated with better neurologic function at last follow-up, as well as greater likelihood of being able to walk again. The Tokuhashi score was found to be more accurate than the modified Bauer score in predicting the neurological outcome after surgery.
Collapse
Affiliation(s)
- Michael G. Kontakis
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Panagiotis Tsagkozis
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
|
2
|
Lenschow M, Lenz M, Telentschak S, von Spreckelsen N, Sircar K, Oikonomidis S, Kernich N, Walter SG, Knöll P, Perrech M, Goldbrunner R, Eysel P, Neuschmelting V. Preoperative Performance Status Threshold for Favorable Surgical Outcome in Metastatic Spine Disease. Neurosurgery 2024; 95:770-778. [PMID: 38587396 DOI: 10.1227/neu.0000000000002941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/08/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical treatment is an integral component of multimodality management of metastatic spine disease but must be balanced against the risk of surgery-related morbidity and mortality, making tailored surgical counseling a clinical challenge. The aim of this study was to investigate the potential predictive value of the preoperative performance status for surgical outcome in patients with spinal metastases. METHODS Performance status was determined using the Karnofsky Performance Scale (KPS), and surgical outcome was classified as "favorable" or "unfavorable" based on postoperative changes in neurological function and perioperative complications. The correlation between preoperative performance status and surgical outcome was assessed to determine a KPS-related performance threshold. RESULTS A total of 463 patients were included. The mean age was 63 years (range: 22-87), and the mean preoperative KPS was 70 (range: 30-100). Analysis of clinical outcome in relation to the preoperative performance status revealed a KPS threshold between 40% and 50% with a relative risk of an unfavorable outcome of 65.7% in KPS ≤40% compared with the relative chance for a favorable outcome of 77.1% in KPS ≥50%. Accordingly, we found significantly higher rates of preserved or restored ambulatory function in KPS ≥50% (85.7%) than in KPS ≤40% (48.6%; P < .001) as opposed to a significantly higher risk of perioperative mortality in KPS ≤40% (11.4%) than in KPS ≥50% (2.1%, P = .012). CONCLUSION Our results underline the predictive value of the KPS in metastatic spine patients for counseling and decision-making. The study suggests an overall clinical benefit of surgical treatment of spinal metastases in patients with a preoperative KPS score ≥50%, while a high risk of unfavorable outcome outweighing the potential clinical benefit from surgery is encountered in patients with a KPS score ≤40%.
Collapse
Affiliation(s)
- Moritz Lenschow
- Center for Neurosurgery, University of Cologne, Cologne , Germany
| | - Maximilian Lenz
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany
| | | | | | - Krishnan Sircar
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany
| | - Stavros Oikonomidis
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany
| | - Sebastian G Walter
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany
| | - Peter Knöll
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany
| | - Moritz Perrech
- Center for Neurosurgery, University of Cologne, Cologne , Germany
| | | | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany
| | | |
Collapse
|
|
3
|
Wick JB, Kalistratova VS, Jr DP, Fine JR, Boozé ZL, Holland J, Vander Voort W, Hisatomi LA, Villegas A, Conry K, Ortega B, Javidan Y, Roberto RF, Klineberg EO, Le HV. A Comparison of Prognostic Models to Facilitate Surgical Decision-Making for Patients With Spinal Metastatic Disease. Spine (Phila Pa 1976) 2023; 48:567-576. [PMID: 36799724 DOI: 10.1097/brs.0000000000004600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/30/2022] [Indexed: 02/18/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Compare the performance of and provide cutoff values for commonly used prognostic models for spinal metastases, including Revised Tokuhashi, Tomita, Modified Bauer, New England Spinal Metastases Score (NESMS), and Skeletal Oncology Research Group model, at three- and six-month postoperative time points. SUMMARY OF BACKGROUND DATA Surgery may be recommended for patients with spinal metastases causing fracture, instability, pain, and/or neurological compromise. However, patients with less than three to six months of projected survival are less likely to benefit from surgery. Prognostic models have been developed to help determine prognosis and surgical candidacy. Yet, there is a lack of data directly comparing the performance of these models at clinically relevant time points or providing clinically applicable cutoff values for the models. MATERIALS AND METHODS Sixty-four patients undergoing surgery from 2015 to 2022 for spinal metastatic disease were identified. Revised Tokuhashi, Tomita, Modified Bauer, NESMS, and Skeletal Oncology Research Group were calculated for each patient. Model calibration and discrimination for predicting survival at three months, six months, and final follow-up were evaluated using the Brier score and Uno's C, respectively. Hazard ratios for survival were calculated for the models. The Contral and O'Quigley method was utilized to identify cutoff values for the models discriminating between survival and nonsurvival at three months, six months, and final follow-up. RESULTS Each of the models demonstrated similar performance in predicting survival at three months, six months, and final follow-up. Cutoff scores that best differentiated patients likely to survive beyond three months included the Revised Tokuhashi score=10, Tomita score=four, Modified Bauer score=three, and NESMS=one. CONCLUSION We found comparable efficacy among the models in predicting survival at clinically relevant time points. Cutoff values provided herein may assist surgeons and patients when deciding whether to pursue surgery for spinal metastatic disease. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Joseph B Wick
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | | | | | - Jeffrey R Fine
- University of California, Davis, Department Biostatistics, Sacramento, CA
| | - Zachary L Boozé
- University of California, Davis, School of Medicine, Sacramento, CA
| | - Joseph Holland
- University of Louisville School of Medicine, Louisville, KY
| | - Wyatt Vander Voort
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | | | - Alex Villegas
- University of California, Davis, School of Medicine, Sacramento, CA
| | - Keegan Conry
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Brandon Ortega
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Yashar Javidan
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Rolando F Roberto
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Hai V Le
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| |
Collapse
|
|
4
|
Optimization of Tokuhashi Scoring System to Improve Survival Prediction in Patients with Spinal Metastases. J Clin Med 2022; 11:jcm11185391. [PMID: 36143035 PMCID: PMC9503025 DOI: 10.3390/jcm11185391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Predicting survival time for patients with spinal metastases is important in treatment choice. Generally speaking, six months is a landmark cutoff point. Revised Tokuhashi score (RTS), the most widely used scoring system, lost its accuracy in predicting 6-month survival, gradually. Therefore, a more precise scoring system is urgently needed. Objective: The aim of this study is to create a new scoring system with a higher accuracy in predicting 6-month survival based on the previously used RTS. Methods: Data of 171 patients were examined to determine factors that affect prognosis (reference group), and the remaining (validation group) were examined to validate the reliability of a new score, adjusted Tokuhashi score (ATS). We compared their discriminatory abilities of the prediction models using area under receiver operating characteristic curve (AUC). Results: Target therapy and the Z score of BMI (Z-BMI), which adjusted to the patients’ sex and age, were additional independent prognostic factors. Patients with target therapy use are awarded 4 points. The Z score of BMI could be added directly to yield ATS. The AUCs were 0.760 for ATS and 0.636 for RTS in the validation group. Conclusion: Appropriate target therapy use can prolong patients’ survival. Z-BMI which might reflect nutritional status is another important influencing factor. With the optimization, surgeons could choose a more individualized treatment for patients.
Collapse
|
|
5
|
Van den Brande R, Cornips EM, Peeters M, Ost P, Billiet C, Van de Kelft E. Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review. J Bone Oncol 2022; 35:100446. [PMID: 35860387 PMCID: PMC9289863 DOI: 10.1016/j.jbo.2022.100446] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Spinal metastases (SM) are a frequent complication of cancer and may lead to pathologic vertebral compression fractures (pVCF) and/or metastatic epidural spinal cord compression (MESCC). Based on autopsy studies, it is estimated that about one third of all cancer patients will develop SM. These data may not provide a correct estimation of the incidence in clinical practice. Objective This systematic review (SR) aims to provide a more accurate estimation of the incidence of SM, MESCC and pVCF in a clinical setting. Methods We performed a SR of papers regarding epidemiology of SM, pVCF, and MESCC in patients with solid tumors conform PRISMA guidelines. A search was conducted in the PubMed and Web of Science database using the terms epidemiology, prevalence, incidence, global burden of disease, cost of disease, spinal metastas*, metastatic epidural spinal cord compression, pathologic fracture, vertebral compression fracture, vertebral metastas* and spinal neoplasms. Papers published between 1975 and august 2021 were included. Quality was evaluated by the STROBE criteria. Results While 56 studies were included, none of them reports the actual definition used for MESCC and pVCF, inevitably introducing heterogenity. The overall cumulative incidence of SM and MESCC is 15.67% and 2.84% respectively in patients with a solid tumor. We calculated a mean cumulative incidence in patients with SM of 9.56% (95% CI 5.70%-13.42%) for MESCC and 12.63% (95% CI 7.00%-18.25%) for pVCF. Studies show an important delay between onset of symptoms and diagnosis. Conclusions While the overall cumulative incidence for clinically diagnosed SM in patients with a solid tumor is 15.67%, autopsy studies reveal that SM are present in 30% by the time they die, suggesting underdiagnosing of SM. Approximately 1 out of 10 patients with SM will develop MESCC and another 12.6% will develop a pVCF. Understanding these epidemiologic data, should increase awareness for first symptoms, allowing early diagnosis and subsequent treatment, thus improving overall outcome.
Collapse
Key Words
- CA, carcinoma
- CI, confidence interval
- Epidemiology
- HCC, hepatocellular carcinoma
- LOL, length of life
- MESCC, metastastic epidural spinal cord compression
- MRI, magnetic resonance imaging
- Metastatic epidural spinal cord compression
- OR, odds ratio
- Oncology
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- Pathologic vertebral compression fracture
- QOL, quality of life
- RCT, randomized controlled trial
- SINS, spinal instability neoplastic score
- SM, spinal metastases
- SR, systematic review
- SRE, skeletal related event
- ST, solid tumor
- STROBE, Strengthening the reporting of observational studies in epidemiology
- Spinal metastases
- WHO, World Health Organization
- pVCF, pathologic vertebral compression fractures
- rMESCC, subclinical radiographic MESCC
Collapse
Affiliation(s)
- Ruben Van den Brande
- University of Antwerp, Belgium
- Department of Neurosurgery, Ziekenhuis Oost Limburg Genk, Belgium
| | - Erwin Mj Cornips
- Department of Neurosurgery, Ziekenhuis Oost Limburg Genk, Belgium
| | - Marc Peeters
- University of Antwerp, Belgium
- Department of Oncology, Antwerp University Hospital, Belgium
| | - Piet Ost
- Iridium Network, Antwerp, Belgium
- Department of Radiotherapy, GZA Hospital, Antwerp, Belgium
| | - Charlotte Billiet
- Iridium Network, Antwerp, Belgium
- Department of Radiotherapy, GZA Hospital, Antwerp, Belgium
| | - Erik Van de Kelft
- University of Antwerp, Belgium
- Department of Neurosurgery, Vitaz Sint-Niklaas, Belgium
| |
Collapse
|
|
6
|
Schoenfeld AJ, Ferrone ML, Blucher JA, Agaronnik N, Nguyen L, Tobert DG, Balboni TA, Schwab JH, Shin JH, Sciubba DM, Harris MB. Prospective comparison of the accuracy of the New England Spinal Metastasis Score (NESMS) to legacy scoring systems in prognosticating outcomes following treatment of spinal metastases. Spine J 2022; 22:39-48. [PMID: 33741509 PMCID: PMC8443703 DOI: 10.1016/j.spinee.2021.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT We developed the New England Spinal Metastasis Score (NESMS) as a simple, informative, scoring scheme that could be applied to both operative and non-operative patients. The performance of the NESMS to other legacy scoring systems has not previously been compared using appropriately powered, prospectively collected, longitudinal data. PURPOSE To compare the predictive capacity of the NESMS to the Tokuhashi, Tomita and Spinal Instability Neoplastic Score (SINS) in a prospective cohort, where all scores were assigned at the time of baseline enrollment. PATIENT SAMPLE We enrolled 202 patients with spinal metastases who met inclusion criteria between 2017-2019. OUTCOME MEASURES One-year survival (primary); 3-month mortality and ambulatory function at 3- and 6-months were considered secondarily. METHODS All prognostic scores were assigned based on enrollment data, which was also assigned as time-zero. Patients were followed until death or survival at 365 days after enrollment. Survival was assessed using Kaplan-Meier curves and score performance was determined via logistic regression testing and observed to expected plots. The discriminative capacity (c-statistic) of the scoring measures were compared via the z-score. RESULTS When comparing the discriminative capacity of the predictive scores, the NESMS had the highest c-statistic (0.79), followed by the Tomita (0.69), the Tokuhashi (0.67) and the SINS (0.54). The discriminative capacity of the NESMS was significantly greater (p-value range: 0.02 to <0.001) than any of the other predictive tools. The NESMS was also able to inform independent ambulatory function at 3- and 6-months, a function that was only uniformly replicated by the Tokuhashi score. CONCLUSIONS The results of this prospective validation study indicate that the NESMS was able to differentiate survival to a significantly higher degree than the Tokuhashi, Tomita and SINS. We believe that these findings endorse the utilization of the NESMS as a prognostic tool capable of informing care for patients with spinal metastases.
Collapse
Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Justin A Blucher
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Nicole Agaronnik
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Lananh Nguyen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Tracy A Balboni
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| |
Collapse
|
|
7
|
Carrwik C, Olerud C, Robinson Y. Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study. BMJ Open 2021; 11:e049198. [PMID: 34725074 PMCID: PMC8562515 DOI: 10.1136/bmjopen-2021-049198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate survival after surgery and indications for surgery due to spinal metastatic disease. DESIGN A retrospective longitudinal multiregistry nationwide cohort study. SETTING 19 public hospitals in Sweden with spine surgery service, where 6 university hospitals account for over 90% of the cases. PARTICIPANTS 1820 patients 18 years or older undergoing surgery due to spinal metastatic disease 2006-2018 and registered in Swespine, the Swedish national spine surgery registry. INTERVENTIONS Decompressive and/or stabilising spine surgery due to spinal metastatic disease. PRIMARY OUTCOME Survival (median and mean) after surgery. SECONDARY OUTCOMES Indications for surgery, types of surgery and causes of death. RESULTS The median estimated survival after surgery was 6.2 months (95% CI: 5.6 to 6.8) and the mean estimated survival time was 12.2 months (95% CI: 11.4 to 13.1). Neurologic deficit was the most common indication for surgery and posterior stabilisation was performed in 70.5% of the cases. A neoplasm was stated as the main cause of death for 97% of the patients. CONCLUSION Both median and mean survival times were well above the generally accepted thresholds for surgical treatment for spinal metastases, suggesting that patient selection for surgical treatment on a national level is adequate. Further research on quality of life after surgery and prognostication is needed.
Collapse
Affiliation(s)
- Christian Carrwik
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Yohan Robinson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Research and Development, Armed Forces Centre for Defence Medicine, Vastra Frolunda, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| |
Collapse
|
|
8
|
Carrwik C, Olerud C, Robinson Y. Does knowledge of the primary tumour affect survival after surgery for spinal metastatic disease? A retrospective longitudinal cohort study. BMJ Open 2021; 11:e050538. [PMID: 34433605 PMCID: PMC8388281 DOI: 10.1136/bmjopen-2021-050538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To compare survival after surgery for patients with spinal metastatic disease with known primary tumour (KPT) versus patients with unknown primary tumour (UPT). PARTICIPANTS 393 patients 18 years or older (270 men and 123 women, mean age 67.3 years) undergoing surgery at Uppsala University Hospital in Swedenbetween 2006 and 2016due to spinal metastatic disease . 271 patients (69%) had a KPT at the time of surgery and 122 (31%) had an UPT. INTERVENTIONS Decompressive and/or stabilising spine surgery due to spinal metastatic disease. PRIMARY OUTCOME Survival (median and mean) after surgery. RESULTS The estimated median survival time after surgery for patients with KPT was 7.4 months (95% CI 6.0 to 8.7) and mean survival time was 21.6 months (95% CI 17.2 to 26.0). For patients with UPT, the median estimated survival time after surgery was 15.6 months (95% CI 7.5 to 23.7) and the mean survival time was 48.1 months (95% CI 37.3 to 59.0) (Breslow, p=0.001). Unknown primary cancer was a positive predictor of survival after surgery (Cox regression, HR=0.58, 95% CI 0.46 to 0.73). CONCLUSION In this study, patients with spinal metastasis and UPT had a longer expected survival after surgery compared with patients with KPT. This suggests that patients with UPT and spinal metastasis should not be withheld from surgery only based on the fact that the primary tumour is unknown.
Collapse
Affiliation(s)
- Christian Carrwik
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Yohan Robinson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Research and Development, Armed Forces Centre for Defence Medicine, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
|
9
|
Chen Q, Chen X, Zhou L, Chen F, Hu A, Wang K, Liang H, Jiang L, Li X, Dong J. The emergence of new prognostic scores in lung cancer patients with spinal metastasis: A 12-year single-center retrospective study. J Cancer 2021; 12:5644-5653. [PMID: 34405024 PMCID: PMC8364647 DOI: 10.7150/jca.60821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/07/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: Lung cancer patients exhibit spinal metastases from a specific population, and with this study, we aimed to develop a model that can predict this particular group's survival. Methods: Data were retrospectively collected from 83 lung cancer patients who underwent spinal metastasis surgery at our center from 2009 to 2021. After the initial assessment of treatment and scoring effects, a nomogram for survival prediction was created by identifying and integrating critical prognostic factors, followed by a consistency index (C-index) to measure consistency, and finally, a subject working characteristic curve (ROC) to compare the predictive accuracy of the three existing models. Results: The mean postoperative survival was 14.7 months. Surgical treatment significantly improved the VAS and Frankel scores in lung cancer patients with spinal metastases. The revised Tokuhashi score underestimated the life expectancy of these patients. Six independent prognostic factors, including age, extraspinal bone metastasis foci, visceral metastasis, Frankel score, targeted therapy, and radiotherapy, were identified and incorporated into the model. Calibration curves for 3-, 6-, and 12-month overall survival showed a good concordance between predicted and actual risk. The nomogram C-index for the cohort study was 0.800 (95% confidence interval [CI]: 0.757-0.843). Model comparisons showed that the nomogram's prediction accuracy was better than revised Tokuhashi and Bauer's scoring systems. Conclusions: Spine surgery offered patients the possibility of regaining neurological function. Having identified shortcomings in existing scoring systems, we have recreated and validated a new nomogram that can be used to predict survival outcomes in patients with spinal metastases from lung cancer, thereby assisting spinal surgeons in making surgical decisions and personalizing treatment for these patients.
Collapse
Affiliation(s)
- Qing Chen
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaohui Chen
- Department of Orthopaedic, First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, China
| | - Lei Zhou
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fancheng Chen
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Annan Hu
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ketao Wang
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haifeng Liang
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Libo Jiang
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xilei Li
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
|
10
|
Ehne J, Tsagozis P. Current concepts in the surgical treatment of skeletal metastases. World J Orthop 2020; 11:319-327. [PMID: 32908816 PMCID: PMC7441493 DOI: 10.5312/wjo.v11.i7.319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients’ quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the relatively few high-quality studies in this field. Generally, prosthetic reconstruction has been shown to result in fewer implant failures and should be preferred in patients with a good prognosis. Survival estimation tools should be used as part of preoperative planning. Adjuvant treatment, which relies on radiotherapy and inhibition of osteoclast function may also offer symptomatic relief and prevent implant failure. In this review we discuss the epidemiology, indications for surgery, preoperative planning, surgical techniques and adjuvant treatment of metastatic bone disease.
Collapse
Affiliation(s)
- Jessica Ehne
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
| | - Panagiotis Tsagozis
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
| |
Collapse
|